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Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample.

Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample.
Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample.
Objectives: Many adult patients hospitalised with acute respiratory illness have viruses detected but the overall importance of viral infection compared to bacterial infection is unclear.

Methods: Patients were recruited from two acute hospital sites in Leicester (UK) over 3 successive winters. Samples were taken for viral and bacterial testing.

Results: Of the 780 patients hospitalised with acute respiratory illness 345 (44%) had a respiratory virus detected. Picornaviruses were the most commonly isolated viruses (detected in 23% of all patients). Virus detection rates exceeded 50% in patients with exacerbation of asthma (58%), acute bronchitis and Influenza-like-illness (64%), and ranged from 30 to 50% in patients with an exacerbation of COPD (38%), community acquired pneumonia (36%) and congestive cardiac failure (31%). Bacterial detection was relatively frequent in patients with exacerbation of COPD and pneumonia (25% and 33% respectively) but was uncommon in all other groups. Antibiotic use was high across all clinical groups (76% overall) and only 21% of all antibiotic use occurred in patients with detectable bacteria.

Conclusions: Respiratory viruses are the predominant detectable aetiological agents in most hospitalised adults with acute respiratory illness. Antibiotic usage in hospital remains excessive including in clinical conditions associated with low rates of bacterial detection. Efforts at reducing excess antibiotic use should focus on these groups as a priority.

Registered International Standard Controlled Trial Number: 21521552.
respiratory viruses, acute respiratory illness, hospitalisation, adults, antibiotics
0163-4453
507-515
Clark, Tristan W.
712ec18e-613c-45df-a013-c8a22834e14f
Medina, Marie-Jo
651f91ae-0995-459f-baa1-c3b4978adc25
Batham, Sally
271a3b6b-495c-4aca-8e68-f13f10f10394
Curran, Martin D.
f8d611e4-a2f5-4720-8a0a-b030a13784ab
Parmar, Surendra
191a5173-cfed-4c07-bee7-53c7902b7bf8
Nicholson, Karl G.
27948033-015f-4e4f-a8ed-1df896b42b0a
Clark, Tristan W.
712ec18e-613c-45df-a013-c8a22834e14f
Medina, Marie-Jo
651f91ae-0995-459f-baa1-c3b4978adc25
Batham, Sally
271a3b6b-495c-4aca-8e68-f13f10f10394
Curran, Martin D.
f8d611e4-a2f5-4720-8a0a-b030a13784ab
Parmar, Surendra
191a5173-cfed-4c07-bee7-53c7902b7bf8
Nicholson, Karl G.
27948033-015f-4e4f-a8ed-1df896b42b0a

Clark, Tristan W., Medina, Marie-Jo, Batham, Sally, Curran, Martin D., Parmar, Surendra and Nicholson, Karl G. (2014) Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample. Journal of Infection, 69 (5), 507-515. (doi:10.1016/j.jinf.2014.07.023). (PMID:25108123)

Record type: Article

Abstract

Objectives: Many adult patients hospitalised with acute respiratory illness have viruses detected but the overall importance of viral infection compared to bacterial infection is unclear.

Methods: Patients were recruited from two acute hospital sites in Leicester (UK) over 3 successive winters. Samples were taken for viral and bacterial testing.

Results: Of the 780 patients hospitalised with acute respiratory illness 345 (44%) had a respiratory virus detected. Picornaviruses were the most commonly isolated viruses (detected in 23% of all patients). Virus detection rates exceeded 50% in patients with exacerbation of asthma (58%), acute bronchitis and Influenza-like-illness (64%), and ranged from 30 to 50% in patients with an exacerbation of COPD (38%), community acquired pneumonia (36%) and congestive cardiac failure (31%). Bacterial detection was relatively frequent in patients with exacerbation of COPD and pneumonia (25% and 33% respectively) but was uncommon in all other groups. Antibiotic use was high across all clinical groups (76% overall) and only 21% of all antibiotic use occurred in patients with detectable bacteria.

Conclusions: Respiratory viruses are the predominant detectable aetiological agents in most hospitalised adults with acute respiratory illness. Antibiotic usage in hospital remains excessive including in clinical conditions associated with low rates of bacterial detection. Efforts at reducing excess antibiotic use should focus on these groups as a priority.

Registered International Standard Controlled Trial Number: 21521552.

Full text not available from this repository.

More information

Accepted/In Press date: 31 July 2014
e-pub ahead of print date: 6 August 2014
Published date: November 2014
Keywords: respiratory viruses, acute respiratory illness, hospitalisation, adults, antibiotics
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 386394
URI: https://eprints.soton.ac.uk/id/eprint/386394
ISSN: 0163-4453
PURE UUID: 5d119611-86d8-4aff-9037-8ef29cdf5799
ORCID for Tristan W. Clark: ORCID iD orcid.org/0000-0001-6026-5295

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Date deposited: 01 Feb 2016 12:02
Last modified: 06 Jun 2018 12:23

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